Therapy And Support Groups For Social Skills Issues
I want this site to let people know about all of their options for working on their social issues. As I mention in another article, one way to get help and support is to see a counselor one-on-one. Similarly, you could also attend a therapy or support group. This article will provide a general overview of them, and how they can help. Groups are a common treatment for social anxiety, Asperger's Syndrome, and a general lack of knowledge about social rules. In some ways groups are especially suited for social issues, because taking part in one is a safe, supportive social experience in itself.
My general philosophy towards using any kind of therapy or mental health services is that it can be useful for any severity of problem. It's not something that's only for really messed up people, just like how you don't have to be morbidly obese to go to a personal trainer. If you think seeing someone may help, and you're willing to go, then why not?
Quick note: In this article I use 'counselor/counseling' and 'therapist/therapy' interchangeably.
Treatment vs. Support groups
I'll clarify the difference between treatment, or therapy, groups and support groups. In general group therapy involves meeting with some other people, and one or two facilitators. You're all there to work on specific issues, but the form that takes varies depending on what type of group you're attending. Two forms you'll usually see when it comes to social skills issues are:
Treatment groups are more like little courses. They're more structured, focused on teaching, and they have a clear outcome they're trying to reach. They're lead by one or more mental health professionals, who have instructor-like roles. An example would be a 10-week group designed to reduce symptoms of social anxiety by teaching its members principles and techniques based on Mindfulness Meditation. Each session would cover specific pre-planned items. A second example would be a general social skills training group, with each week covering a topic such as body language, assertive communication, and so on.
Support groups are less structured and more open-ended. They're pretty much what they sound like. They're a place where a group of people who have a common issue can meet to support and help each other. The emphasis is on the members sharing with each other, rather than most of the content coming from a professional. An example would be an ongoing bi-monthly group where men with Asperger's Syndrome can talk to each other about the challenges of trying to socialize in their work and personal lives. Support groups may be facilitated by a mental health professional, but rather than going through a curriculum their aim is to help the discussion stay productive and on track. A trained counselor doesn't always facilitate. A support group may be organized and run entirely by its members.
Groups may also be a mix of the two. For example, a monthly support group for people with social anxiety may begin with a quick lesson or presentation about a certain aspect of interpersonal skills, after which the members can talk to each other, with that topic kicking off the discussion.
What group therapy involves
Each therapy group is a bit different. A session could involve discussion among members, instruction from the facilitators, and in-class and real-world exercises. I'll go into more detail about what various groups are like below. As I was saying, treatment groups are more led and organized, while support groups let the members talk to each other.
Groups usually have about 6-12 members. Some treatment groups have more participants if they're very instruction-focused, and the members aren't interacting with each other as much. Groups can be open or closed. In a closed group once the members are set, no one new comes in. You may see this in a limited-duration treatment group. Open groups allow new members. You'll more often see this arrangement in ongoing support groups.
A worry some people have about groups is that they're not comfortable speaking to a bunch of strangers, and that they'll be made to talk during any discussion/sharing portions. No one will force you to speak if you don't want to, though of course you'll get some general prodding and encouragement. Like a lot of things, many people find that speaking up in a group isn't that bad once they experience it, though they may need a few sessions of hanging back and watching before they warm up to the idea.
Topics that may be covered in various types of social skills treatment groups
Each social skills treatment group is going to be a little different, depending on how the facilitators decide to organize it. They'll generally cover the following, however:
Social Anxiety treatment groups
Here the emphasis is on dealing with anxiety, though because those feelings come up in social situations, some interpersonal skills get covered as well. They're usually taught from a Cognitive Behavioral perspective, that is, the school of psychology which holds that a person's thoughts, feelings, and behaviors are tied together, and that by influencing one, you can affect the others. These groups usually cover:
- An explanation of Cognitive Behavioral principles, e.g., explaining how knee jerk negative thoughts such as, "Everyone at the party will hate me" can trigger anxiety, and then providing a system for thinking more realistically and constructively..
- The teaching of breathing and relaxation techniques for managing anxiety.
- Teaching some socializing techniques the members may not know (e.g., some general rules for making small talk, so when the members talk to people the fact that they don't know how to do it isn't contributing to their nervousness).
- Exercises where members get to experience firsthand that they don't appear as outwardly nervous as they feel (e.g., members may be asked to sing in front of everyone else, and rate their anxiety on a scale of 1-100. As they perform they may give themselves a 90, but when asked how nervous they looked, the other members may only rate them a 40).
- Role playing exercises where group members can practice dealing with a variety of anxiety-inducing situations such as job interviews, turning down an unreasonable request, asking someone to hang out, etc.
- In-class exposure exercises, where members confront fear-inducing situations and realize they can handle them (e.g., members practice asking each other for the time, only to have the other person get mad at them. Everyone realizes that when this happens, rather than feeling horrendously embarrassed, they just think the other person is a jerk).
- Real world exposure exercises (e.g., the facilitator may take everyone to a nearby grocery store, where the members have to ask other shoppers for help. Once they're comfortable talking to people under a pretext, they may try to initiate small talk for its own sake.
As mentioned, these types of groups, and the kind I'll cover below, may have time devoted to discussion/sharing/support among the members.
Social skills training groups
These groups are about teaching people basic social skills they missed out on acquiring by themselves There are general topics they all tend to cover, but the content will vary a bit based on the type of group. For example, a social skills training group aimed at people with Asperger's Syndrome may devote more time to helping the members deal with the particular social weaknesses the condition causes (e.g., reading facial expressions, give-and-take in conversation, deducing what other's internal thoughts are).
Commonly taught topics are:
- Listening skills
- Non-verbal communication (e.g., eye contact, body language, personal space)
- Explanations of various unwritten social rules
- Conversation skills (e.g., ways to start, maintain, and end one)/li>
- Assertive communication techniques
- Social problem solving (e.g., what would you do if you found out a friend hadn't invited you to a party).
- Specific scenarios (e.g., dealing with someone being rude to you, approaching your boss to ask a question, etc.)
Training groups usually start with some instruction on the principles to be taught that day. Afterward, members may engage in a variety of exercises and structured role-plays. There may be homework practice assignments for the members to do in-between sessions. The instructors will give the participants feedback, in person, or perhaps by recording and re-watching practice interactions. As the weeks go by, the focus may shift away from role playing and more to real-life socializing. Later sessions may involve staging a party where the members all try to naturally mingle with each other. Volunteers may enter the group to serve as practice conversation partners, so the members don't just get used to talking to each other.
Benefits of groups
Attending a treatment group has some obvious benefits. As you read in the section above, you'll be taught specific concepts, techniques, and skills that can help you with your social issues. You'll likely get to practice the concepts through in-class and real world exercises, and homework assignments. That alone would be a good enough reason to join one for many people.
As I mentioned at the top of the article, another huge benefit of group treatment is that being in a group is a social experience in and of itself. This applies to any kind of group, whether it's one for gambling addicts, or people who are caring for a spouse with cancer. By interacting with the other members, in a specially safe, supportive, confidential environment, you're likely to grow and change. If you were to join a support group you'd still be getting these kinds of benefits, even though you wouldn't be directly taught as much information.
It's not unusual for group members to become friends with each other either. Some people balk at this idea and think, "Oh no. I'm a regular person and I'll be attending a group. But that's different. All the other members are probably super messed up. I could never be friends with them." Once they start the group they see that the other participants are just like them. They may not be compatible friends-wise with every last one of them, but they see they're not complete deviants either.
The therapist Irvin D. Yalom identified several general therapeutic factors that can help people in all kinds of therapy groups. If you're going to describe group therapy, you can't really leave his list out. Some that are most relevant to improving social skills are:
Imparting of information
This one is straightforward, and I've already mostly covered it. The information could come from the group leader, or from another member sharing something. There are lots of examples to be made here. Like the therapist explaining a technique for holding eye contact, or another member sharing a small talk trick that makes things easier for her.
Development of socializing techniques
This one may seem a little confusing, because it's not describing the explicit teaching of techniques you may see in a social skills group. The way Yalom is using it this point is referring to something that can arise from the interactions that takes place among members in any kind of therapy group. Via the general discussion, the group provides a safe place where members can try out new ways of relating to others. For example, a member who is normally too shy to share his thoughts can learn to speak up and offer his opinion to another member. Or a participant could learn to assert themselves when a more talkative person cuts them off mid-sentence, rather than reverting to their usual response of abandoning what they were going to say.
While interacting with the other members, the person in the group learns more about how they come across in social situations. For example, they might get direct feedback on how they're sometimes too quick to focus on the negative. They may feel irritated by another member, before realizing they do some of the same things themselves.
This refers to how someone can learn new ways of interacting by watching the leader and other members. E.g., they notice the mannerisms the leader uses that show she's being a good listener, they pick up on the conversational style of one of the more friendly, happy-go-lucky members, etc.
It can be very healing for people to belong to a tight, cohesive group where they feel accepted, especially if they've never had this experience before.
Some of the other factors Yalom identified aren't as immediately relevant to improving social skills but can still be very important benefits:
Installation of hope
This is when the group gives you the sense of, "I can see that people are working past this, or have already dealt with the issues I'm dealing with. I can do it too."
When you see firsthand that other people share your issues and struggles, and that you're not some lone freak for having the problems you do. E.g., someone with social anxiety could hear another member talk about their crippling fear of spilling food on themselves while eating in front of others, something they thought only they worried about.
Catharsis is when you gain a feeling of relief by expressing and releasing strong emotions. For example, a group member may feel better after telling everyone about his long pent-up insecurity that no one will ever like him because he's overweight.
The group provides the opportunity to help other people, which can raise a person's self-esteem and teach them new styles of interacting with others.
The group experience can also help people explore and deal with bigger, more existential concerns, like figuring out the meaning of their lives, or coming to grips with their mortality.
Corrective Recapitulation of the Primary Family Group
This one is a little more complicated. Basically, the idea is that when people first join a group they can unconsciously transfer their feelings and baggage about their family onto other members. For example, they may see the therapist leading the group as being like their overly critical mother. They may see another talkative member as their popular, attention-seeking brother. If all goes well the group member can have a more safe, positive experience with this substitute family, and work through some of their childhood issues.
The effectiveness of social skills groups
A lot of research studies have evaluated the effectiveness of various social skills groups. What they find is that they help, but just a little. That sounds bleak, and like I'm undercutting the whole point of this article, but I'll try to put that finding in perspective. If someone has a lot of difficulty socializing, an 8-week treatment group, or a monthly visit to a support group, isn't going to miraculously cure all their problems, but it's still useful. I think it's like if a 12-year-old basketball player went to a special training camp over the summer. His skills are going to be better after he's done, and he may have picked up some foundational principles that will continue to improve his game long down the road, but in the grand scheme of things he's still twelve and a work in progress. All things being equal it was better for his development that he attended the camp, but it isn't going to single-handedly get him into the NBA.
Where to find social skills groups
If the idea of joining a group interests you there are a couple of ways to find them:
- If you're in university or college your school's counseling services probably offers a variety of groups. If they don't have one regarding social skills, you could always request that they look into starting one.
- You can always do a search on the internet for terms like 'social anxiety support group (your city)'
- Sometimes sites like Craigslist will have relevant listings in the Groups page of the Community section.
- Mental health agencies in your community may offer a group that fits your needs. For example, the local branch of a Mood Disorders Association may offer support groups for anxiety. An organization that provides autism-related services may hold social skills training groups for adults with Asperger's Syndrome. Even if a particular agency doesn't have the kind of group you'd like, you could always get in contact and ask if they can point you in the right direction.
- You could ask your doctor what he knows about groups in the area. If you're seeing a counselor one-on-one, you could also ask them.
- If you're in high school you could talk to the school's guidance counselor or social worker. If you have a good relationship with your parents, you could even ask them to help you find one.